What is multiple sclerosis?

Multiple sclerosis (MS) is a disease of the central nervous system (the brain and spinal cord). People who have multiple sclerosis may lose coordination and muscle control. However, many people with multiple sclerosis are only mildly affected by the disease and continue to lead their lives much as they did before their diagnosis.

How does it occur?

The cause of multiple sclerosis is still unknown. For reasons not yet understood, random areas of the fatty substance (myelin) that covers nerve fibers is lost. The myelin normally insulates entire nerve fibers. It helps nerve messages to be properly conducted to and from the brain. The areas of myelin that are lost are called plaques. The symptoms of multiple sclerosis depend on where these plaques are in the central nervous system.

Currently, most scientists believe that the loss of myelin is caused by a virus or an autoimmune process. In the case of an autoimmune process, the body mistakenly reacts to some part of itself as foreign and attacks it. MS may result from a combination of a virus and autoimmunity. That is, a person might be infected with a virus that then causes the body to react and destroy the myelin.

What are the symptoms?

Often the first symptoms of MS are vague feelings of weakness, clumsiness, or exhaustion. Your vision may become blurry, or one or more areas of your skin may feel numb and tingling. Usually these symptoms come and go unpredictably. The times when you are having symptoms are called episodes. The episodes may last a few days or weeks at a time.

Other possible symptoms include:

• double vision

• weakness of limbs

• muscle stiffness

• dizziness

• loss of bladder control

• depression

• memory loss.

The times between episodes, when you are not having symptoms, are called remissions. Many people with MS are able to function quite normally between episodes.

How is it diagnosed?

The best test for MS is MRI (magnetic resonance imaging). MRI produces x-ray-like images that are better than other methods for seeing certain areas of the central nervous system. With MRI it is possible to see the places where myelin has been lost.

If the diagnosis is still uncertain after MRI, the doctor may do a test that measures how fast your nerves conduct impulses. Also, a sample of fluid from your spine may be analyzed for protein changes that are often found in people who have MS.

More than one MRI may be done over time. Several MRIs may show plaques appearing in different areas of the central nervous system at different times. This confirms the diagnosis of multiple sclerosis.

How is it treated?

There is not yet a cure for MS. However, treatment with medication can help shorten episodes of symptoms and increase the time between episodes.

Steroids are used for short-term treatment of episodes of symptoms. These drugs can shorten the times that you have symptoms.

The goal of long-term treatment is to help the remissions (the symptom-free times) to last longer. Two types of drugs are used for this: interferons and Copaxone (glutiramer acetate). These medications lengthen the time between episodes of symptoms and they may actually slow the development of disability.

Some of the symptoms of MS, such as stiffness and bladder problems, may be helped with other medicines.

How long do the effects last?

People with multiple sclerosis have many episodes and remissions. Some people never have more than a few mild, infrequent symptoms. However, with time, the episodes may become more frequent and/or last longer. Some loss of function may continue between episodes. In some cases the disease eventually results in severe disability.

What kind of ongoing care do I need?

The most important aspect of care is emotional support. You may feel anxiety, anger, and fear. You may need help in getting treatment for the depression that often accompanies MS.

Caring for someone with MS requires a team approach. In addition to physicians (often including a neurologist), other members of your health care team may include a physical therapist, occupational therapist, social worker, and counselor. The goal is to enable you to be as independent as possible while helping you deal with the intense emotional consequences of a potentially disabling disease.

What can be done to help prevent multiple sclerosis?

Because the cause of MS is not known, we do not yet know how to prevent it.